W&I newborn test garners attention

PROVIDENCE – A screening test developed at Women & Infants Hospital to identify babies at risk for cognitive and emotional problems was featured in the Dec. 7 issue of the journal Pediatrics and is now being tried at research centers across the United States and abroad.

Identifying at-risk infants is important because early intervention can help prevent or reduce problems with school readiness and behavior. But tests used so far have not been very helpful.

The new test, developed by a team led by Barry Lester, director of the Brown Center for the Study of Children at Risk at Women & Infants and The Warren Alpert Medical School of Brown University, yields more precise and useful results, Lester said.

Called the NICU (neonatal intensive-care unit) Network Neurobehavioral Scale (NNNS), the test was created under a contract for the National Institutes of Health and has been evaluated as part of a large, multi-site project also led by Lester, the Maternal Lifestyle Study.

Over a period of two years, the NNNS exam was given to more than 1,200 babies in Providence, Detroit, Memphis and Miami, Lester said, and the team identified five different neurobehavioral profiles, ranging from “normal” to “poor” performance.

Infants who scored in the “poor” range were likelier than others to have behavior problems by age 3, school readiness problems by age 4, and low IQ by age 4 1/2.

Forty percent had clinically significant problems externalizing (impulsivity and acting out), internalizing (anxiety, depression, withdrawn personalities), and with school readiness (delays in motor, concepts and language skills), and 35 percent had low IQ, the team found.

“One of the reasons that it has been so difficult to use tests on infants to predict later development is that infancy is a period of rapid change,” Lester said in a news release. “We’re measuring a moving target. Many children appear ‘normal’ as babies but develop problems later on, and many children who appear worrisome as babies go on to develop normally.”

There are known factors that can put children at risk, such as being born prematurely or being exposed to their mother’s substance use during pregnancy, as well as poverty and exposure to violence at an early age.

But not all babies who have historically been identified as “high-risk” grow up to have problems, Lester said. The NNNS profiles aim to refine the screening system, so the risk profiles are not only more accurate, but also more specifically identify the children’s needs.

“The NNNS profiles identify the neurobehavioral deficits associated with poor outcomes that could serve as target behaviors for the development of new or improved intervention studies,” Lester said. “These findings can be used to guide programmatic intervention efforts targeted to those with indicated dysfunction.”

But there are caveats, Lester noted, and his project’s findings “could also stimulate an important social policy debate.”

Even the NNNS may fail to identify many infants who later develop behavior problems, he noted, and it will identify many infants as high-risk who develop normally.

“The latter could suffer the negative effects of being labeled, and resources would be used unnecessarily,” he said. “On the other hand, the NNNS is non-invasive, early intervention is benign, and there is the ethical responsibility of offering early intervention to parents whose infants have a 40 percent chance of having a childhood behavior disorder or school readiness problem.”

The NNNS exam is now being used in centers in the United States and around the world for both research and intervention. Women & Infants offers training for professionals who want to use the tool.

The Pediatrics article on the NNNS tool can be read online here. To learn more about the Brown Center for the Study of Children at Risk, go to the center’s Web site.